NSAID links with heart attack may be limited to NSTEMI
MedWire News: Use of the non-steroidal anti-inflammatory (NSAID) drug diclofenac is associated with an increased risk for non-ST-segment elevation myocardial infarction (NSTEMI), research suggests.
By contrast, other NSAIDs analyzed in the study - namely, ibuprofen and naproxen - were associated with a nonsignificant reduced risk for NSTEMI, and none of the painkillers was associated with risk for STEMI.
The findings add to a growing body of evidence that suggests diclofenac increases the risk for MI in current nonaspirin users, report Lamiae Grimaldi-Bensouda (Institut Pasteur, Paris, France) and co-authors in the journal Heart.
Although previous studies have examined the association between NSAID use and MI, this is the first to address the association in STEMI and NSTEMI specifically, they continue.
The matched case-control analysis compared 1152 incident cases of STEMI (67.3%) and NSTEMI (32.7%) from a French nationwide registry of 55 cardiology centers. These cases were matched for age and gender to 2790 controls from general practice settings.
The findings revealed that current use (in the 2 months prior to enrollment) of diclofenac was not significantly associated with the occurrence of STEMI, but was significantly associated with an increased occurrence of NSTEMI (odds ratio [OR]=2.8).
Further analysis revealed that current use of arylpropionic acid (AA) NSAIDs including ibuprofen and naproxen and related AAs also displayed no association with STEMI, but tended towards a significantly reduced risk for NSTEMI (OR=0.37).
The overall heterogeneity between the ORs of STEMI and NSTEMI for the main NSAID classes was statistically significant (p=0.02).
"This suggests that the observable effects of NSAID use, whether positive or negative, differ between STEMI and NSTEMI and are limited to NSTEMI," explain the authors.
Naproxen and related AA NSAIDs preferentially inhibit an enzyme that favors thrombosis, which may allow them to act on the limited thrombosis seen in NSTEMI, the authors hypothesize. However, this action may not be sufficient to prevent the larger thromboses seen in STEMI.
Therefore, "cardiac prevention by aspirin should be maintained in patients at risk also taking naproxen and related AA NSAIDs," they say.
"As this is the first observation of a differential effects of NSAIDs on these outcomes, confirmation through additional research is required," Grimaldi-Bensouda and team conclude.
MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010
By Piriya Mahendra